• Severe temper outbursts at least three times a week
• Sad, irritable, or angry mood almost every day
• Reaction is bigger than expected
• Trouble functioning in more than one place

Criterion A. Severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation.

Criterion B. The temper outbursts are inconsistent with developmental level.

Criterion C. The temper outbursts occur, on average, 3 or more times per week.

Criterion D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others.

Criterion E. Criteria A, B, C, and D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A to D.

Criterion F. Criteria A and D are present in at least 2 of the 3 settings (home, school, with peers) and are severe in at least 1 of these.

Criterion G. The diagnosis should not be made for the first time before age 6 years or after age 18 years.

Criterion H. By history or observation, the age of onset of Criteria A to E is before 10 years.

Criterion I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.

• Note: Developmentally appropriate mood elevation, such as when occurring in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.

Criterion J. The beavhiors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder.

• Note: DMDD diagnosis cannot co-exist with the following diagnoses: oppositional defiant disorder (ODD), intermittent explosive disorder, bipolar disorder.
• Note: If symptoms meet criteria for both DMDD and ODD, the individual should be assigned the diagnosis of DMDD only.
• Note: If the individual has ever experienced a manic or hypomanic episode, the diagnosis of DMDD should not be assigned.

Criterion K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition.